Alcoholism threatens the health of millions of Americans in the United States. Alcoholic fatty liver disease, or steatosis, is one of the earliest and most common consequences of excess alcohol consumption and can lead to more severe forms of liver injury, including cirrhosis, diabetes, hepatitis, fibrosis and hepatocellular carcinoma. Therefore, understanding the pathogenesis of alcohol-induced fatty liver disease is of great clinical and basic importance. Recent studies have suggested that response to stress in the endoplasmic reticulum (ER), or unfolded protein response (UPR) may be involved in the pathogenesis of alcoholic liver disease. This is a very attractive model because the ER is the predominant site for lipid biosynthesis, lipid droplet biogenesis, and alcohol detoxification, and because hepatic ER has been reported to expand in alcoholics. However, the causal relationship between ER stress and alcoholic fatty liver has yet to be established. We and others have recently shown that the IRE11-XBP1 branch of the UPR pathway plays a critical role in lipid metabolism. Excitingly, our preliminary data reveal that acute alcohol challenge doubled the activity of IRE11 in the liver within minutes, suggesting that ER stress occurs at an early stage following alcohol consumption. Moreover, ER stress was observed in two chronic-binge drinking mouse models with more severe forms of liver injury. Hence, the goal of this R21 proposal is to delineate the role of the IRE11-XBP1 branch in the pathogenesis of alcoholic fatty liver disease. We hypothesize that the IRE11-XBP1 branch of UPR directly regulates the lipogenic program in the liver in response to chronic-binge alcohol drinking, thereby playing a key role in the pathogenesis of alcoholic fatty liver disease. This hypothesis identifies the IRE11-XBP1 branch and ER homoeostasis as key components linking chronic-binge alcohol drinking and alcoholic fatty liver disease. Using state of the art methodology (e.g. adenoviral shRNA to achieve gene- and liver-specific temporal knockdown, Phos-tag-based method to quantitate ER stress under physiological conditions and tissue ChIP-qPCR to quantitate the binding of a transcription factor to specific gene promoters in the liver), we will test this hypothesis with the following Aims: (1) To determine how modulation of the IRE11-XBP1 pathway affects the pathogenesis of alcoholic fatty liver; (2) To explore the fundamental mechanism by which the IRE11-XBP1 pathway regulates lipogenic genes in response to alcohol. If successful, this study will establish, for the first time to our knowledge, a causal relationship between the UPR and alcoholic fatty liver disease. Relevance to human health: Excessive alcohol intake is a leading cause of chronic liver disease worldwide. Of those who drink (over 50% adults in US), about 29% report binge drinking on multiple occasions each month (i.e. chronic-binge drinkers), which results in about 1.5 billion episodes of binge drinking in the US each year. Fatty liver disease, one of the earliest and most common consequences of excessive heavy or binge drinking, can lead to more severe forms of liver injuries, including hepatitis, cirrhosis, and hepatocellular carcinoma. Our study will provide critical insights into the pathogenesis of alcohol-induced fatty liver disease. This study, if successful, may delineate key signaling pathways in alcoholic liver disease and identify new targets for preventing and treating alcoholic liver diseases as well as other forms of liver diseases. PUBLIC HEALTH RELEVANCE: Endoplasmic reticulum (ER) is a dynamic cellular structure that expands upon chronic alcohol drinking. This proposal tests a novel hypothesis that the activation of the IRE11-XBP1 pathway of the ER stress response upon alcohol consumption contributes significantly to the pathogenesis of alcoholic hepatic steatosis (faty liver) through direct regulation of the lipogenic program. This study, if successful, may establish a causal relationship between ER stress and alcoholic fatty liver, and provide one or more candidate targets for drug intervention in conditions exacerbated by excessive heavy or binge drinking.